Emphysema Nursing Care Plan Notes


  1. Emphysema is the enlargement and destruction of the alveolar, bronchial, and bronchiolar tissue with resultant loss of recoil, air trapping, thoracic overdistention, sputum accumulation, and loss of diaphragmatic muscle tone.
  2. These changes cause a state of carbon dioxide retention,hypoxia, and respiratory acidosis.

The actual cause of emphysema is unknown. Risk factors for the development of emphysema include cigarette smoking, living or working in a highly polluted area, and a family history of pulmonary disease. Frequent childhood pulmonary infections have been identified as a cause of bronchiectasis.Emphysema

  1. Anorexia, fatigue, weight loss
  2. Feeling of breathlessness,cough, sputum production, flaring of the nostrils, use of accessory muscles of respiration, increased rate and depth of breathing, dyspnea.
  3. Decreased respiratory excursion,resonance to hyperresonance, decreased breath sounds with prolonged expiration, normal or decreased fremitus
Primary Nursing Diagnosis
  • Impaired gas exchange related to destruction of alveolar walls
Diagnostic Evaluation
  • Evaluation entails primarily chest x-rays, chest computed tomography (CT) scans, pulmonary function tests, pulse oximetry, blood gases, and complete blood count.
Medical Management

The major goals of medical management are to improve quality of life, slow progression of the disease, and treat obstructed airways to relieve hypoxia. Treatment is directed at improving ventilation, decreasing work of breathing and preventing infection.

  • Smoking cessation
  • Physical therapy to conserve and increase pulmonary ventilation
  • Maintenance of proper environmental conditions to facilitate breathing
  • Psychological support
  • Ongoing program of patient education and rehabilitation
  • Bronchodilators and metered-dose inhalers (aerosol therapy, dispensing particles in fine mist).
  • Treatment of infection (antimicrobial therapy at the first sign of respiratory infection)
  • Oxygenation in low concentrations for severe hypoxemia.
Pharmacologic Intervention
  • Bronchodilators: Anticholinergic agents such as atropine sulfate, ipratropium bromide are used in reversal of bronchoconstriction.
  • Bronchodilators: Beta2-adrenergic agents such as( inhaled beta2-adrenergic agonists by metered-dose inhaler (MDI) such as albuterol, metaproterenol, or terbutaline )are used in reversal of bronchoconstriction
  • Systemic corticosteroids such as methylprednisolone IV; prednisone PO is used to decrease inflammatory response and improve airflow in some patients for a few days during acute exacerbations
  • Other Drug Therapy: Bronchodilators, which are used for prevention and maintenance therapy, can be administered as aerosols or oral medications. Generally, inhaled anticholinergic agents are the first-line therapy for emphysema, with the addition of betaadrenergic agonists added in a stepwise fashion. Antibiotics are ordered if a secondary infection develops. As a preventive measure, influenza and pneumonia vaccines are administered.
Nursing Interventions
  • Maintaining a patent airway is a priority. Use a humidifier at night to help the patient mobilize secretions in the morning.
  • Encourage the patient to use controlled coughing to clear secretions that might have collected in the lungs during sleep.
  • Instruct the patient to sit at the bedside or in a comfortable chair, hug a pillow, bend the head downward a little, take several deep breaths, and cough strongly.
  • Place patients who are experiencing dyspnea in a high Fowler position to improve lung expansion. Placing pillows on the overhead table and having the patient lean over in the orthopneic position may also be helpful. Teach the patient pursed-lip and diaphragmatic breathing.
  • To avoid infection, screen visitors for contagious diseases and instruct the patient to avoid crowds.
  • Conserve the patient’s energy in every possible way. Plan activities to allow for rest periods, eliminating nonessential procedures until the patient is stronger. It may be necessary to assist with the activities of daily living and to anticipate the patient’s needs by having supplies within easy reach.
  • Refer the patient to a pulmonary rehabilitation program if one is available in the community.
  • Patient education is vital to long-term management. Teach the patient about the disease and its implications for lifestyle changes, such as avoidance of cigarette smoke and other irritants, activity alterations, and any necessary occupational changes. Provide information to the patient and family about medications and equipment.
Documentation Guidelines
  • Rate, quality, and depth of respirations; vital signs
  • Physical findings: Dyspnea, cyanosis, decreased muscle mass, cough, increased anteroposterior chest diameter, and use of accessory muscles during respiration; characteristics of sputum
  • Activity tolerance, ability to perform self-care
  • Signs and symptoms of infection; response to pharmacologic therapy, response to oxygen therapy
Discharge and Home Healthcare Guidelines
  • Be sure the patient and family understand any medication prescribed, including dosage, route, action, and side effects.
  • Instruct the patient to report any signs and symptoms of infection to the primary healthcare provider.
  • Explain necessary dietary adjustments to the patient and family. Recommend eating small, frequent meals, including high-protein, high-density foods.
  • Encourage the patient to plan rest periods around his or her activities, conserving as much energy as possible.
  • Arrange for return demonstrations of equipment used by the patient and family. If the patient requires home oxygen therapy, refer the patient to the appropriate rental service, and explain the hazards of combustion and increasing the flow rate without consultation from the primary healthcare provider.